Guidelines for claims submission, such as which services are covered, and reimbursement rates is dictated by:

Question 62 options:

	the insurance company
	he healthcare provider
	the insured
	the insured's employer

Question 63 (1.25 points)

If a payment problem develops with an insurance company and the company ignores claims and exceeds time limits to pay a claim, it is prudent to contact

Question 63 options:

	federal insurance commissioner.
	state insurance commissioner.
	state insurance federation.
	department of public service.

Question 64 (1.25 points)

A secondary insurance may not be billed until the primary insurance has denied or paid the claim.

Question 64 options:

	True
	False

Question 65 (1.25 points)

A common reason for denial of medical claims due to lack of medical necessity, is if the diagnosis code and the procedure code do not match.

Question 65 options:

	True
	False

Question 66 (1.25 points)

Insurance companies are rated according to the number of complaints received about them

Question 66 options:

	True
	False

Question 67 (1.25 points)

If the medical practice receives payment from an insurance company that is more than the contract rate, it is called a/an ________.

Question 67 options:

Question 68 (1.25 points)

request for a hearing before an administrative law judge (in a Medicare case) may be made if the amount still in question is ________or more.

Question 68 options:

Question 69 (1.25 points)

The process of identifying and reviewing specific reasons for claim denials is referred to as _

Question 69 options:

Question 70 (1.25 points)

Documentation from private insurance carriers sent to participating providers that accompanies payment and describes the response to a claim is referred to by the acronym ________

Question 70 options: